Prescription
Main formulas
Huo xiang zheng qi san
Hao qin qing dan tang
Alternative formula
Qiang huo sheng shi tang
Modifications
Patent remedy
Main points
Explanations
Alternative points
Modifications
Stagnation of Liver-Qi
Symptoms and signs
Principle of treatment
Prescription
Main formula
Chai hu shu gan san
Alternative formulas
Xiao yao san
Jia wei xiao yao san
Da chai hu tang
Zuo jin wan
Modifications
Patent remedies
Main points
Explanations
Alternative points
Modifications
Diagnosis
Principle of treatment
Herbal treatment
Chai hu shu gan san
Explanations
Stagnation of Blood
Symptoms and signs
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Hypochondriac pain
Agastache Upright Qi Powder. This formula is very effective at treating hypochondriac and epigastric pain due to invasion of Cold-Damp. Chuan Lian Zi Fructus Meliae Toosendan 10g and Yan Hu Suo Rhizoma Corydalis 10g, etc., could be added into the prescription to increase the effect of relieving the pain.
Artemisia Annua and Scutellaria Decoction to Clear the Gallbladder. This formula is designed to dispel the External pathogenic factors, clear the Heat, eliminate Damp-Phlegm, harmonise the Stomach and relieve the vomiting, indicated in hypochondriac pain and epigastric pain. Chuan Lian Zi Fructus Meliae Toosendan 10g and Yan Hu Suo Rhizoma Corydalis 10g, etc., could be added into the prescription to relieve the pain.
Notopterygium Dispelling Dampness Decoction. When there is general muscle pain together with the pain at the hypochondriac region, this formula could be applied.
This formula has function to dispel Wind, eliminate Cold, resolve the Damp and relieve the pain. Ge Gen Radix Puerariae 10g, Gui Zhi Ramulus Cinnamomi 6g and Xi Xian Cao Herba Siegesbeckiae 10g could be added relieve the pain.
1. If there is severe pain, add Xiang Fu Rhizoma Cyperi 10g to promote the Qi circulation and relieve the pain
2. If there is severe vomiting, add Sha Ren Fructus Amomi 6g to cause the Stomach-Qi to descend and relieve the vomiting
3. If there is very poor appetite, add Mai Ya Fructus Hordei Germinatus 20g to improve the appetite
4. If there is much diarrhoea, add Ge Gen Radix Puerariae 10g to relieve the diarrhoea
5. If there are severe External symptoms, add Du Huo Radix Angelicae Pubescentis 10g to promote the sweating and relieve the External symptoms.
Huo Xiang Zheng Qi Wan Agastache Upright Quian Pill.
LI-4 Hegu, TE-5 Waiguan, CV-12 Zhongwan, LR-3 Taichong, PC-6 Neiguan, ST-36 Zusanli and SP-3 Taibai. Reducing method is used on the first three points; even method is used on the last two points.
▪ LI-4, the Source point of Large Intestine channel, TE-5, the Connecting point of the Triple Burner channel, can expel the Damp from the Exterior and relieve the Exterior symptoms
▪ CV-12, the Front Collecting point of the Stomach, and ST-36, the Lower Sea point of the Stomach, can regulate the Stomach-Qi, expel the Damp-Phlegm and stop the pain
▪ LR-3, a Source point of the Liver channel, and PC-6, the Confluence point for the Yin Linking Vessel, regulate the Liver-Qi and stop the pain
▪ SP-3, the Source point of the Spleen channel, can strengthen the Spleen, harmonise the Stomach and transform the Damp in the body.
BL-12 Fengmen, GB-20 Fengchi, GB-22 Yuanye, GB-24 Riyue, GB-34 Yanglingquan, GB-41 Zulinqi, LU-7 Lieque, and SP-6 Sanyinjiao, etc.
1. If there is severe cold feeling, apply indirect moxibustion with ginger on CV-8, to transform the Damp, warm the Interior and eliminate the Cold
2. If there is severe hypochondriac pain, add LR-5 and GB-40 to harmonise the Liver and Gallbladder, regulate the channels and collaterals and relieve the pain
3. If there is severe vomiting, add ST-40, the Connecting point of the Stomach channel, to harmonise the collateral, descend the Stomach-Qi and relieve the vomiting
4. If there is much diarrhoea, add SP-9 to activate the Spleen and relieve the diarrhoea
5. If there is high fever, add LI-11 to clear the Heat and reduce the fever.
Symptoms and signs are hypochondriac pain with distending and moving features, which starts or worsens in stressful situations, with distension in the sides of abdomen, and a sensation of fullness in the gastric region and stifling in the chest, accompanied by shortness of breath, a reduced appetite, belching, a thin, white tongue coating and a wiry pulse.
If the stagnant Liver-Qi produces Liver-Fire, there will also be irritability, heartburn, a bitter taste in the mouth, scanty urine and constipation, a tongue that is red, or red at the edges, with a yellow coating and a wiry, forceful and rapid pulse.
Smooth the Liver, promote the Liver-Qi circulation and stop the pain.
Bupleurum Soothing the Liver Powder. This formula is good for promoting the Liver-Qi circulation and relieving the pain in the Liver, Gallbladder, Stomach and Large Intestine, etc. Usually Chuan Lian Zi Fructus Meliae Toosendan 10g and Yan Hu Suo Rhizoma Corydalis 10g, etc., could be added into the prescription to increase the effect of relieving the pain.
Free and Relaxed Powder. This formula has better function to smooth the Liver, but its function to relieve the pain is limited.
Chuan Xiong Radix Ligustici Wallichii 10g, Xiang Fu Rhizoma Cyperi 10g, Chuan Lian Zi Fructus Meliae Toosendan 10g and Yan Hu Suo Rhizoma Corydalis 10g, etc., could be added into the prescription to increase the effect of relieving the pain.
Augmented Rambling Powder. This formula is formed based upon XIAO YAO SAN Free and Relaxed Powder by adding Mu Dan Pi Cortex Moutan Radici and Zhi Zi Fructus Gardeniae, indicated in stagnation of Liver-Qi with formation of Heat or Fire in the Liver. Xiao Ku Cao Spica Prunellae 10g, Chi Shao Yao Radix Paeoniae Rubrae 10g and Huang Qin Radix Scutellariae 10g could be added into the prescription to clear the Heat, reduce the Fire in the Liver and calm the Liver, and Xiang Fu Rhizoma Cyperi 10g, Chuan Lian Zi Fructus Meliae Toosendan 10g and Yan Hu Suo Rhizoma Corydalis 10g, etc., could be added into the prescription to increase the effect of relieving the pain.
Major Bupleurum Decoction. This formula harmonisess the Liver and relieves the obstructions, particularly indicated in hypochondriac pain due to Liver-Qi stagnation with accumulation of Excessive Heat in the Stomach and Large Intestine. When there is hypochondriac pain without Heat accumulation, then this formula is contraindicated.
Left Metal Pill. This formula can often be used in combination with one of above formulas, indicated in formation of Liver-Fire with invasion of the Liver-Fire to the Stomach, causing much epigastric pain and acid regurgitation.
1. If the distending pain is severe, add Qing Pi Pericarpium Citri Reticulatae Viride 10g to break up the Qi stagnation in the Liver and stop the pain
2. If there is a fixed pain in the hypochondriac region, add Yu Jin Radix Curcumae 10g to promote the Qi movement and Blood circulation and stop the pain
3. If the pain is associated with the sides of the lower abdomen, and there is Cold in the Liver channel, add Wu Yao Radix Linderae 5g to expel the Cold from the channel, disperse the Liver-Qi and relieve the pain
4. If there is a digestive disorder, add Chen Pi Pericarpium Citri Reticulatae 5g to regulate the Stomach-Qi, and Mu Xiang Radix Aucklandiae 5g to regulate the Qi of the Liver and Large Intestine, and promote the digestion
5. If the Liver-Qi partially turns to Liver-Heat, there is slight irritability and warm sensation in the chest, add Huang Qin Radix Scutellariae 12g to clear the Heat in the Liver
6. If the Liver-Qi turns into Liver-Fire, which is manifested as thirst, a bitter taste in the mouth, irritability, insomnia, a red tongue with a dry yellow coating and a wiry, rapid pulse, add Long Dan Cao Radix Gentianae Longdancao 10g to clear Heat and reduce the Liver-Fire
7. If there is severe Insomnia and palpitations, add Huang Lian Rhizoma Coptidis 5g to clear the Fire of the Heart and calm the Shen.
Xiao Yao Wan Free and Relaxed Pill.
Shu Gan Wan Soothe Liver Pill.
Long Dan Xie Gan Wan Gentiana Draining the Liver Pill.
TE-6 Zhigou, GB-34 Yanglingquan, LR-3 Taichong, LR-14 Qimen, PC-6 Neiguan, LU-7 Lieque and SP-6 Sanyinjiao. Reducing method is used on the first five points; even method is used on SP-6.
▪ TE-6, a River point of the Triple Burner, regulates the Qi in the Lesser Yang channel. It is very effective for treating hypochondriac pain.
▪ GB-34, a Lower Sea point of the Gallbladder, regulates the Liver-Qi and stops the hypochondriac pain.
▪ LR-3, a Source point of the Liver channel, and LR-14 and PC-6 regulate the Liver-Qi and stop the pain.
▪ LU-7, a Connecting point of the Lung channel and the Confluence point of the Directing Vessel, disperses and causes the Qi to descend in the body generally so as to assist the free flow of the Liver-Qi. It is particularly effective for treating hypochondriac pain accompanied by distension in depression, premenstrual tension and hyperventilation.
▪ SP-6, where the three Yin channels of foot meet, regulates the Blood so as to assist the movement of the Qi.
GB-23 Zhejin, GB-35 Yangjiao, GB-40 Qiuxu, GB-42 Diwuhui, PC-4 Ximen, and LI-4 Hegu, etc.
1. If there is severe fullness and swelling at hypochondriac region and epigastric region, add CV-12, the Gathering point for the Fu organs, to regulate the Qi in the Stomach and relieve the fullness and swelling feeling
2. If there is severe constipation, add ST-25, the Front Collecting point of the Large Intestine, to regulate the Qi in the Large Intestines, promote the defecation and relieve the constipation
3. If there is a fixed pain with distending sensation, add BL-18 and LR-14, the Back Transporting point and the Front Collecting point of the Liver respectively, to regulate the movement of the Liver-Qi, BL-17 and LR-13, the Gathering point for the Blood and the Zang organs respectively, to invigorate the Blood circulation and relieve the pain.
4. If there is Liver-Heat, add LR-2 and GB-43, the Spring points of the Liver channel and Gallbladder channel respectively, to clear the Heat and reduce the regulate the Liver.
5. If there is pain in the sides of lower abdomen, add LR-12 to unblock the obstruction and stop the pain.
A 55-year-old woman had been suffering from hypochondriac pain following an emotional disturbance for 10 days. The pain was moving, and accompanied by a distending sensation, belching throughout the day, acid regurgitation, a reduced appetite and dream-disturbed sleep. She had a red tongue with a dry, yellow coating and a wing pulse.
Stagnation of Liver-Qi. This was an acute Excess syndrome due to stagnation of Liver-Qi resulting from emotional disturbance.
Disperse the Liver-Qi, clear the Liver-Heat, harmo-nise the Stomach and Liver and stop the pain.
Bupleurun Soothing the Liver Powder
Chai Hu Radix Bupleuri 6g
Xiang Fu Rhizoma Cyperi 4.5g
Zhi Qiao Fructus Aurantii 4.5g
Chen Pi Pericarpium Citri Reticulatae 6g
Chuan Xiong Rhizoma Ligustici Chuanxiong 4.5g
Shao Yao Radix Paeoniae Alba 4.5g
Zhi Gan Cao Radix Glycyrrhizae Praeparata 1.5g
And:
ZUO JIN WAN
Left Metal Pill
Huang Lian Rhizoma Coptidis 6g
Wu Zhu Yu Fructus Evodiae 1g.
(Both the latter two are patent formulae.)
l. Chai Hu Shu Gan San disperses the Liver-Qi, softens the Liver, stops the pain and reduces distension in the hypochondriac region.
2. Zuo Jin Wan contains Huang Lian and Wu Zhu Yu. Huang Lian can directly reduce Liver-Heat. Wu Zhu Yu can dispel restrained Liver-Qi and Heat as well as soothing the Stomach-Qi.
After using the herbs for 3 days, the hypochondriac pain and belching were much reduced. After another 3 days’ treatment, all the symptoms had disappeared. The patient was followed up years later and she stated she had experienced no pain since the herbal treatment.
